End-stage Renal Disease Mortality Research Articles

Association of diabetes with cardiovascular calcification and all-cause mortality in end-stage renal disease in the early stages of hemodialysis: a retrospective cohort study

BackgroundThe main goal of this study was to examine how diabetes, cardiovascular calcification characteristics and other risk factors affect mortality in end-stage renal disease (ESRD) patients in the early stages of hemodialysis.MethodsA total of 285 ESRD patients in the early stages of hemodialysis were enrolled in this research, including 101 patients with diabetes. Survival time was monitored, and general data, biochemical results, cardiac ultrasound calcification of valvular tissue, and thoracic CT calcification of the coronary artery and thoracic aorta were recorded. Subgroup analysis and logistic regression were applied to investigate the association between diabetes and calcification. Cox regression analysis and survival between calcification, diabetes, and all-cause mortality. Additionally, the nomogram model was used to estimate the probability of survival for these individuals, and its performance was evaluated using risk stratification, receiver operating characteristic, decision, and calibration curves.ResultsCardiovascular calcification was found in 81.2% of diabetic patients (82/101) and 33.7% of nondiabetic patients (62/184). Diabetic patients had lower phosphorus, calcium, calcium-phosphorus product, plasma PTH levels and lower albumin levels (p < 0.001). People with diabetes were more likely to have calcification than people without diabetes (OR 5.66, 95% CI 1.96–16.36; p < 0.001). The overall mortality rate was 14.7% (42/285). The risk of death was notably greater in patients with both diabetes and calcification (29.27%, 24/82). Diabetes and calcification, along with other factors, collectively predict the risk of death in these patients. The nomogram model demonstrated excellent discriminatory power (area under the curve (AUC) = 0.975 at 5 years), outstanding calibration at low to high-risk levels and provided the greatest net benefit across a wide range of clinical decision thresholds.ConclusionsIn patients with ESRD during the early period of haemodialysis, diabetes significantly increases the risk of cardiovascular calcification, particularly multisite calcification, which is correlated with a higher mortality rate. The risk scores and nomograms developed in this study can assist clinicians in predicting the risk of death and providing individualised treatment plans to lower mortality rates in the early stages of hemodialysis.

A case-control study investigating cardiovascular health in maintenance hemodialysis patients through oxidative stress biomarkers and carotid artery intima-media thickness

Introduction: Chronic kidney disease (CKD) is a major risk factor for the development of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD). Aim: This study aims to evaluate biomarkers of oxidative stress (OS) and carotid artery intima-media thickness as predictors of cardiovascular health among MHD patients. Materials and methods: We divided 135 participants in this prospective case-control study into three groups: group A included 45 healthy controls, group B included 45 ESRD patients receiving MHD for less than three years, and group C included 45 ESRD patients receiving MHD for more than three years. Participants aged 18–50 years, not taking antioxidant supplements, and willing to participate were included, excluding those with chronic illnesses, prior cardiac disease, or acute renal failure. Data collected included demographics, MHD duration, medical history, lipid profile, common carotid artery intima-media thickness (CCA-IMT), and some biochemical parameters such as oxidized LDL (Ox-LDL), malondialdehyde (MDA), and superoxide dismutase (SOD). Results: This study included 135 participants divided into three groups (A, B, and C) based on the MHD duration. Significant differences were observed in OS markers and lipid profiles across the groups (p&amp;lt;0.001). Group C exhibited the highest levels of Ox-LDL and MDA, indicating increased OS, and the lowest SOD levels compared to groups A and B. Positive correlations were found between Ox-LDL and LDL-cholesterol (LDL-C) levels, with the strongest correlation in group C (r=0.684, p&amp;lt;0.05). CCA-IMT progressively increased from group A to group C, with significant differences in right, left, and mean CCA-IMT (p&amp;lt;0.001). Multivariate analysis revealed a positive association between Ox-LDL levels and CCA-IMT (p&amp;lt;0.01). Conclusion: Increased OS, evident by elevated Ox-LDL and reduced antioxidant levels, is linked to unfavorable lipid profiles and carotid atherosclerosis progression in MHD patients. Prolonged MHD duration contributes to heightened OS and increased atherosclerosis development. Ox-LDL emerges as a predictor of CVD risk in this population.

NT-proBNP point-of-care testing for predicting mortality in end-stage renal disease: A survival analysis

This study examines the predictive value of elevated N-terminal-pro brain natriuretic peptide (NT-pro BNP) levels for mortality among patients with end-stage renal disease (ESRD). Data from 768 ESRD patients, excluding those with cancer or lost follow-up, were analyzed using Kaplan–Meier curves and Cox proportional hazards models over three years. Results indicated that patients with very high NT-pro BNP levels had shorter average survival times and a significantly higher risk of mortality (hazard ratio 1.43). Advanced age, ICU admission, and comorbidities like cerebrovascular diseases and chronic obstructive pulmonary disease also contributed to increased mortality risks. Thus, elevated NT-pro BNP is an independent risk factor for mortality in ESRD patients.

Temporal trends in hypertension related end stage renal disease mortality rates: an analysis of gender, race/ethnicity, and geographic disparities in the United States.

According to one USA Renal Data System report, 57% of end-stage renal disease (ESRD) cases are attributed to hypertensive and diabetic nephropathy. Yet, trends in hypertension related ESRD mortality rates in adults ≥ 35 years of age have not been studied. The aim of this retrospective study was to analyze the different trends hypertension related ESRD death rates among adults in the United States. Death records from the CDC (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were analyzed from 1999 to 2020 for hypertension related ESRD mortality in adults ≥ 35 years of age. Age-Adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, place of death, and geographic location. Hypertension-related ESRD caused a total of 721,511 deaths among adults (aged ≥ 35 years) between 1999 and 2020. The overall AAMR for hypertension related ESRD deaths in adults was 9.70 in 1999 and increased all the way up to 43.7 in 2020 (APC: 9.02; 95% CI: 8.19-11.04). Men had consistently higher AAMRs than woman during the analyzed years from 1999 (AAMR men: 10.8 vs women: 9) to 2020 (AAMR men: 52.2 vs women: 37.2). Overall AAMRs were highest in Non-Hispanic (NH) Black or African American patients (45.7), followed by NH American Indian or Alaska Natives (24.7), Hispanic or Latinos (23.4), NH Asian or Pacific Islanders (19.3), and NH White patients (15.4). Region-wise analysis also showed significant variations in AAMRs (overall AAMR: West 21.2; South: 21; Midwest: 18.3; Northeast: 14.2). Metropolitan areas had slightly higher AAMRs (19.1) than nonmetropolitan areas (19). States with AAMRs in 90th percentile: District of Columbia, Oklahoma, Mississippi, Tennessee, Texas, and South Carolina, had roughly double rates compared to states in 10th percentile. Overall hypertension related ESRD AAMRs among adults were seen to increase in almost all stratified data. The groups associated with the highest death rates were NH Black or African Americans, men, and populations in the West and metropolitan areas of the United States. Strategies and policies targeting these at-risk groups are required to control the rising hypertension related ESRD mortality.

Left Ventricular Mass Index in End-Stage Renal Disease Patients during Hemodialysis and Continuous Ambulatory Peritoneal Dialysis.

One of the primary reasons for high mortality in end-stage renal disease (ESRD) is cardiovascular disease in patients with renal replacement therapy (RRT). Left ventricular hypertrophy (LVH) significantly predicts mortality and cardiovascular events. We assess the left ventricular mass index change in two dialysis methods: hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). The factors associated with increased left ventricular mass index (LVMI). We recruit more than 50 HD patients and 45 CAPD patients with LVH of similar age, gender, dialysis duration, and LVMI for one-year follow-up. The LVMI in the group of HD patients after one year increased from 180.28 ± 45.32 g/m2 to 212.58 ± 66.22 g/m2 (p = 0.001), while the LVMI in the group of patients with CAPD increased from 190.16 ± 66.01 g/m2 to 197.42 ± 78 g/m2 (p = 0.32). Multivariable logistic regression analysis, we demonstrated that dialysis by HD (β = -1,167, 95% CI: 0.104-0.938, p = 0.036) and anemia treatment lower the goals (β = 1.9566, 95% CI: 1.466-34.094, p = 0.015) were two factors associated with the progression of the LVMI. The LVH of end-stage renal disease patients with HD treatment is worse than CAPD treatment after a follow-up in one year. Dialysis by periodic hemodialysis and anemia treatment that fails to achieve the goal are risk factors associated with increased progression of LVMI in patients with ESRD.

Impact of sarcopenia on long-term survival after cardiac surgery for end-stage renal disease patients.

The long-term mortality of end-stage renal disease (ESRD) patients is still unsatisfactory. Therefore, long-term risk assessments in ESRD patients undergoing cardiac surgery are needed. Recently, sarcopenia is major concern in cardiac surgery because of its association with poor long-term survival. However, the impact of sarcopenia on the long-term survival of ESRD patients undergoing cardiac surgery is not well understood. Eighty-two ESRD patients who underwent elective cardiac surgery were enrolled. Sarcopenia was identified based on noncontrast abdominal computed tomography. The impact of preoperative and intraoperative factors on long-term survival was investigated. Forty-three patients (52%) were diagnosed with sarcopenia. The in-hospital mortality rate was 4.9%. The 5-year overall survival rate was 48%. The multivariate analyses revealed that STS score ≥ 4 (odds ratio, 6.0; confidence interval, 2.5-14.7; p < 0.01) and presence of sarcopenia (odds ratio, 2.4; confidence interval, 1.3-4.5; p = 0.03) were independent risk factors for overall survival. The 5-year survival rates of low-risk (Society of Thoracic Surgeons score of < 4) patients without sarcopenia, low-risk with sarcopenia, more than intermediate-risk (Society of Thoracic Surgeons score of ≥ 4) without sarcopenia, and more than intermediate-risk with sarcopenia groups were 80%, 51%, 50%, and 26%, respectively. Among the ESRD patients, the low risk without sarcopenia group showed an excellent long-term survival, in contrast to more than intermediate-risk patients with sarcopenia, who can expect poor long-term survival. Preoperative assessment of sarcopenia in addition to the surgical risk score can be useful in developing a therapeutic strategy.

VGG16-based intelligent image analysis in the pathological diagnosis of IgA nephropathy

ObjectiveIgA nephropathy (IgAN) is the most common primary glomerular disease worldwide, with heterogeneous clinical and pathological manifestations, and is a common cause of end-stage renal disease. Early detection and effective intervention measures are essential for improving the outcome of IgAN. Machine learning methods can make the pathological analysis, early detection and diagnosis, and prognosis prediction of IgAN more automated and accurate. This article discusses the application of machine learning methods in IgAN, from optimizing pathological diagnosis to discovering non-invasive specific biomarkers, predicting disease progression, and evaluating prognosis. It is the key to reducing the incidence rate and mortality of end-stage renal disease by relying on intelligent image analysis of VGG16 for accurate detection and diagnosis of IgA nephropathy to enable clinical to take effective prevention and treatment measures. MethodsA total of 452 cases of kidney disease admitted to the nephrology department of our hospital from January 2018 to February 2023 were selected, and it was ruled out that pathological diagnosis could not be made due to the small number of samples submitted for renal puncture; After excluding suspected cases of renal biopsy pathology diagnosis and patients who did not undergo immunofluorescence examination, a total of 135 confirmed IgA nephropathy patients were subjected to image analysis. The internationally recognized 5-level semi-quantitative method was used for evaluation, and traditional image processing methods were selected to segment and extract fluorescence deposition areas. Transform the input image into color space and generate a binary image using the adaptive threshold method in the two feature dimensions of color and brightness. Then, VGG16 regions were separated and merged to obtain independent sedimentary regions. VGG16 was used to add BN layers and SE visual attention to fully extract sensitive features with high inter-class similarity and significant intra-class differences in the IgA nephropathy image classification task. The contour, area, and average brightness of each sedimentary region were calculated, and automatic computer recognition of fluorescence deposition intensity and shape was obtained to improve the accuracy of IgA nephropathy image classification. ResultsThe artificial intelligence image analysis based on VGG16 can achieve the interpretation of IgA nephropathy immunofluorescence results with a higher coincidence rate compared to the results of pathological diagnostic doctors. IgA reaches 88.9%, IgG reaches 85.8%, IgM reaches 83.8%, and C3 reaches 88.6%. Therefore, it can assist pathological diagnostic doctors in interpreting IgA nephropathy immunofluorescence. ConclusionBy fully utilizing computer and network technologies to change the pathological workflow, improve the work efficiency of pathological diagnostic doctors, reduce the misdiagnosis rate caused by fatigue during film reading, and make pathological diagnosis more accurate and objective.

#4713 TUMOR NECROSIS FACTOR RECEPTOR 2 POLYMORPHISM (RS1061622) AND INFLAMMATORY RESPONSE IN END-STAGE RENAL DISEASE PATIENTS UNDER DIALYSIS

Abstract Background and Aims Enhanced levels of soluble tumor necrosis factor receptor 2 (sTNFR2) are known to associate with progressive chronic kidney disease (CKD), and is pointed as a potential biomarker for early detection of CKD; moreover, it has been reported as an independent predictor of all-cause mortality in end-stage renal disease (ESRD) patients under dialysis. Despite the increase in TNFR2 and in other inflammatory markers, recognized as risk factors for mortality in dialysis patients, the hypothesis that genetic polymorphisms of those biomarkers might modulate the inflammatory response and, thereby, the patients’ survival predisposition, has been poorly studied. Concerning TNFR2 genetic variants, a single nucleotide polymorphism in TNFR2 (+ 676 T/G; rs1061622), that results in amino acid change at position 196 (Met/Arg), was associated with higher levels of sTNFR2 in inflammatory conditions. The aim of this study was to determine the allelic frequencies of TNFR2 in ESRD patients and controls, and to evaluate its relationship with the circulating levels of inflammatory biomarkers. Method We studied 277 ESRD patients on dialysis and 32 controls, matched for gender, body mass index, and, as far as possible, for age. Real time PCR TaqMan SNP genotyping assay was used to assess allelic frequencies of TNFR2 (rs1061622). We also evaluated the circulating levels of TNF-alpha, sTNFR2, ferritin, hepcidin, elastase and cell-free DNA (cfDNA). Deaths occurring along 1-year follow-up period were recorded and mortality rates were assessed. Results ESRD patients presented higher levels of all studied biomarkers, as compared to controls; their overall mortality rate was 10.5%. Allelic frequencies in ESRD patients and controls were similar for TNFR2 (rs1061622) considering the homozygous and heterozygous individuals (χ2, p = 0.518). Concerning sTNFR2 values, no significant differences were observed between patients with genotypes TT, GG or TG. The GG genotype patients, compared to TT genotype carriers, presented significantly lower ferritin (p = 0.048), hepcidin (p = 0.038), elastase (p = 0.006) and cfDNA levels (p = 0.016); and compared to TG genotype patients, showed significantly lower ferritin (p = 0.039) and a trend towards lower values of hepcidin (p = 0.097), elastase (p = 0.079) and cfDNA (p = 0.0164). TG genotype patients showed higher TNF-alpha (p = 0.049) and a trend towards lower elastase (p = 0.081) than TT genotype subjects. The GG genotype patients presented a trend towards lower mortality rate (6.3%, 7.5%, and 12.4% for GG, TG and TT, respectively). Conclusion No differences were found in the allelic frequencies between controls and ESRD patients. The GG genotype patients for TNFR2 rs1061622 polymorphism showed decreased levels of inflammation, suggesting a more favorable inflammatory response, which is usually associated to a lower mortality risk in these patients. In accordance with the scientific community, recommending studies on genetic survival predisposition in dialysis patients, the polymorphisms of TNFR2 and of other inflammatory biomarkers deserve further studies. Acknowledgements: This work was financed by CESPU, through the project SNPsCKD-GI2-CESPU-2022; FCT, through the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences—UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy—i4HB.

Risk of Gastrointestinal Bleeding in Patients with End-Stage Renal Disease: The Link between Gut, Heart, and Kidneys.

Patients with end-stage renal disease (ESRD) have a five times higher risk of gastrointestinal bleed (GIB) and mortality than the general population. Aortic stenosis (AS) has been associated with GIB from intestinal angiodysplasia. In this retrospective analysis, we obtained data from the 2012 and 2019 National Inpatient Sample. The primary outcome of interest was all-cause in-hospital mortality and risk factors of mortality in patients with ESRD with GIB with aortic valve disorders especially AS. We identified all patients (≥18 years of age) with ESRD (n = 1,707,452) and analyzed based on discharge diagnosis of valvular heart disease (n = 6521) in patients with GIB compared with those without GIB (n = 116,560). Survey statistical methods accounting for strata and weighted data were used for analysis using survey packages in R (version 4.0). Baseline categorical data were compared using Rao-Scott chi square test, and continuous data were compared using Student's t-test. Covariates were assessed using univariate regression analysis, and factors with p value less than 0.1 in the univariate analysis were entered in the final model. The univariate and multivariable associations of presumed risk factors of mortality in ESRD with GIB patients were performed by Cox proportional hazards model censored at length of stay. Propensity score matching was done using MatchIt package in R (version 4.3.0). 1 : 1 nearest neighbour matching was done with propensity scores estimated through logistic regression, in which occurrence of GIB, valvular lesions, and AS was regressed according to other patient characteristics. Among patients with ESRD with valvular heart diseases, AS was found to be associated with increased risk of GIB (adj.OR = 1.005; 95% CI 1.003-1.008; p < 0.01). ESRD patients with AS showed increased risk of lower GIB (OR = 1.04; 95% CI 1.01-1.06; p = 0.02), colonic angiodysplasia (OR = 1.03; 95% CI 1.01-1.05; p < 0.01), stomach and duodenal angiodysplasia (OR = 1.03; 95% CI 1.02-1.06; p < 0.01), need for blood transfusion add pressors as compared to those without AS. However, there was no increased risk of mortality (OR = 0.97; 95% CI 0.95-0.99; p < 0.01).

Sleep apnea in end-stage renal disease patients: risk factors and mortality.

Sleep apnea (SA) is highly prevalent in the end-stage renal disease (ESRD) population. However, the impact of SA on mortality in ESRD is unclear. This study investigates the relationship between SA and mortality in ESRD. The United States Renal Data System was queried in a retrospective cohort study to identify ESRD patients aged 18-100 years who initiated hemodialysis between 2005 and 2013. Diagnoses of SA and comorbidities were determined from International Classification of Disease-9 codes and demographic variables from Centers for Medicare and Medicaid Services Form-2728. Cox proportional hazards models were used to examine the association of SA with mortality controlling for multiple variables. Of 858,131 subjects meeting inclusion criteria, 587 were found to have central SA (CSA) and 22,724 obstructive SA (OSA). The SA cohort was younger and more likely to be male and Caucasian compared to the non-SA cohort, with more diagnoses of tobacco and alcohol use, hypertension, heart failure, and diabetes. Both CSA (adjusted hazard ratio (aHR) = 1.42, 95% confidence interval (CI): 1.29-1.56) and OSA (aHR = 1.35, 95% CI: 1.32-1.37) were associated with increased mortality. Other variables associated with increased mortality included age, dialysis initiation with a catheter or graft, alcohol use, hypertension, and cardiovascular disease. Factors associated with decreased mortality included female sex, black race, Hispanic ethnicity, diagnosis of heart failure or diabetes, and an ESRD etiology of glomerulonephritis or polycystic kidney disease. Since a diagnosis of either OSA or CSA increases mortality risk, early identification of SA and therapy in this ESRD population may improve survival.

Prevalence of hepatitis C virus infection among hemodialysis patients: cohort study

Hepatitis C virus (HCV) is a blood-borne virus that primarily infects the liver and can cause both acute and chronic hepatitis. HCV is one of the leading causes of liver disease worldwide and can lead to cirrhosis, liver failure, and liver cancer if left untreated. Dialysis is the most common reliable and accessible therapeutic approach in end-stage renal disease (ESRD) which increases survival and life expectancy in patients. Despite the screening tests on blood products and devices, nosocomial infections are one of leading causes of morbidity and mortality in ESRD. HCV is more prevalent in ESRD compared to the general population, with an overall prevalence of 9.9% among chronic hemodialysis (CHD) patients in high- and middle-income countries. The objective of this study is to assess the prevalence of occult HCV infection in CHD. All clinical, and demographic data was registered beside blood samples, serological testes and HCV-RNAs from 95 patients; 60.7% were male, with mean age of OCI positive cases was 32.3 ± 14.3 years. Furthermore, three case had detectable viral load which was 54 IU/ml. Inconclusion, there is a risk of OCI among CHD patients that needs follow-up by molecular testing.

Transition-to-dialysis planning, health care use, and mortality in end-stage renal disease.

To evaluate the association of dialysis transition planning factors (eg, nephrologist care, vascular access placement, place of dialysis) with inpatient (IP) stays, emergency department (ED) visits, and mortality. Retrospective cohort study. We used the Humana Research Database to identify 7026 patients with a diagnosis of end-stage renal disease (ESRD) in 2017 who were enrolled in a Medicare Advantage Prescription Drug plan with at least 12 months preindex enrollment, with first ESRD evidence as the index date. Patients with kidney transplant, hospice election, or dialysis preindex were excluded. Transition-to-dialysis planning was defined as optimal (vascular access placed), suboptimal (nephrologist care, but no vascular access), or unplanned (first dialysis in IP stay or ED visit). The cohort was 41% female and 66% White, with a mean age of 70 years. Optimally planned, suboptimally planned, and unplanned transition to dialysis occurred for 15%, 34%, and 44% of the cohort, respectively. Among patients with preindex chronic kidney disease (CKD) stages 3a and 3b, 64% and 55%, respectively, had an unplanned dialysis transition. For patients with preindex CKD stages 4 and 5, 68% and 84%, respectively, had a planned transition. In adjusted models, patients with a suboptimally or optimally planned transition were 57% to 72% less likely to die, 20% to 37% less likely to experience an IP stay, and 80% to 100% more likely to experience an ED visit than patients with an unplanned dialysis transition. A planned transition to dialysis was associated with reduced odds of IP stays and lower mortality.

Hypertension in Patients Receiving Dialysis: A Review of the Current Clinical Approach

Cardiovascular disease is a leading cause of morbidity and mortality in end-stage renal disease (ESRD). Hypertension plays a major contributory role, resulting in progressive left ventricular hypertrophy, and increasing the risk of sudden cardiac death. The prevalence and pathophysiological mechanisms differ fundamentally from the non-dialysis-dependent population. Sodium restriction can be as effective as antihypertensive medication in mitigating the haemodynamic effects resulting from impaired sodium handling. Tailoring dialysate sodium may enhance diffusion and facilitate greater sodium elimination where dietary measures alone prove ineffective. Unlike hypertension in the wider population, volume overload plays a major pathophysiological role in ESRD. Probing dry weight in patients on dialysis who are seemingly euvolaemic enables clinically significant blood pressure (BP) reduction, and translates to improvements in markers of future cardiovascular morbidity and mortality. Pharmacotherapy remains an important aspect in controlling hypertension in dialysis. Although no large-scale studies have identified the optimal medical therapy, numerous meta-analyses and randomised control trials (RCT) have demonstrated the efficacy of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB), calcium channel blockers, β-blockers, and hydralazine/isosorbide dinitrate in the treatment of hypertension in ESRD. Whether the beneficial haemodynamic properties of mineralocorticoid receptor antagonists outweigh the risk of hyperkalaemia is the subject of ongoing RCTs. Numerous meta-analyses have demonstrated that adequate pharmacological control of BP translates to improved cardiovascular morbidity and mortality. The fluctuation of volume status in the inter/intra-dialytic period complicates the diagnosis of hypertension in ESRD. As with patients not receiving dialysis, 24-hour blood pressure monitoring appears to have the greatest sensitivity in diagnosing hypertension and predicting outcomes from hypertension. Where resources are limited, home BP monitoring appears to have the greatest value.

Relationship between gut microbiota and vascular calcification in hemodialysis patients

Introduction Vascular calcification (VC) is an independent risk factor for cardiovascular mortality in end-stage renal disease (ESRD) patients. The pathogenesis of VC is complicated and unclear. Uremic toxins produced by gut microbiota can promote VC. This study aims to identify the differences in gut microbiota between the different VC groups and the main bacteria associated with VC in hemodialysis (HD) patients in an attempt to open up new preventive and therapeutic approaches and define the probable mechanism for VC in HD patients in the future. Methods A total of 73 maintenance HD patients were enrolled in this cross-sectional study. According to the abdominal aortic calcification (AAC) scores, the participants were divided into the high AAC score group and the low AAC score group. High-throughput sequencing of the gut microbiota was performed and the results were evaluated by alpha diversity, beta diversity, species correlation, and model predictive analyses. Results The prevalence of VC was 54.79% (40/73) in the study. The majority of phyla in the two groups were the same, including Firmicutes, Actinobacteriota, Proteobacteria, and Bacteroidota. The microbial diversity in the high AAC score group had a decreasing trend (p = 0.050), and the species abundance was significantly lower (p = 0.044) than that in the low AAC score group. The HD patients with high AAC scores showed an increased abundance of Proteobacteria and decreased abundances of Bacteroidota and Synergistota at the phylum level; increased abundances of Escherichia-Shigella, Ruminococcus_gnavus_group, and Lactobacillus; and decreased abundances of Ruminococcus and Lachnospiraceae_NK4A136_group at the genus level (p<0.05). Escherichia-Shigella and Ruminococcus_gnavus_group were positively correlated with VC, and Ruminococcus, Adlercreutzia, Alistipes, and norank_f__Ruminococcaceae were negatively correlated with VC. Escherichia-Shigella had the greatest influence on VC in HD patients, followed by Ruminococcus and Butyricimonas. Conclusions Our results provide clinical evidence that there was a difference in gut microbiota between the different VC groups in HD patients. Escherichia–Shigella, a lipopolysaccharide (LPS)-producing bacterium, was positively correlated with VC and had the greatest influence on VC. Ruminococcus, a short-chain fatty acid (SCFA)-producing bacterium, was negatively correlated with VC and had the second strongest influence on VC in HD patients. The underlying mechanism is worth studying. These findings hint at a new therapeutic target.

Effect of Zingiber officinale on Lipid Profile and Some Inflammatory Markers in Diabetic Hemodialysis Patients: A Randomized Double-Blind Placebo-Controlled Clinical Trial.

Diabetes, inflammation, and abnormal lipid levels are the main risk factors for mortality in end-stage renal disease (ESRD). The present study aimed to investigate the effects of ginger supplementation on inflammatory markers and lipid profile in diabetic patients with ESRD undergoing hemodialysis. In this study, 44 patients were randomly assigned to either the ginger or the placebo group. The patients in the ginger group received 2000 mg/d ginger for eight weeks, while the control group received the placebo with the same protocol. The serum concentrations of triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), high-density lipoprotein-cholesterol (HDL-c), albumin, and high-sensitivity C-reactive protein (hs-CRP) were measured after a 12- to 14-hours fast at the baseline and the end of the study, as along with the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and Glasgow prognostic score (GPS). Forty-one subjects were analyzed based on the intention-to-treat method of all included patients. Serum levels of TG (p=0.003), hs-CRP (p=0.022), and NLR (p=0.001) decreased significantly in the ginger group compared to the placebo group, while albumin concentration in serum was elevated (p=0.022). However, there were no significant differences in GPS, levels of TC, LDL-C, HDL-C, and PLR within and between the groups (p > 0.05). Ginger administration reduced NLR, hs-CRP, and TG serum levels and increased serum albumin levels in included patients. Thus, ginger can be considered an effective complementary treatment for these patients. This trail is registered with IRCT20191109045382N3.

Cutaneous squamous cell carcinoma and mortality in end-stage renal disease

BackgroundIn the general population, cutaneous squamous cell carcinoma (cSCC) is associated with increased all-cause mortality. Transplant patients have been shown to have an increased risk of developing cSCC, and their cSCC is associated with an increased risk for mortality. In end-stage renal disease (ESRD) patients, there is extensive mortality and immune dysfunction. Because of this immune system dysfunction, we examined whether cSCC is associated with increased risk of all-cause mortality among ESRD patients, as well as the risk factors for cSCC. MethodsWe analyzed ESRD patients in the United States Renal Data System from 2004-2014, excluding organ transplant recipients. We assessed mortality using a Cox Proportional Hazards (CPH) model to control for various demographic and clinical parameters, identified using international classification of diseases (ICD)-9 codes. ResultsOf the 1,035,193 patients included, 624 (0.1%) were diagnosed with cSCC. The median survival time for those with cSCC was 3.91 years [95% confidence interval (CI) = 3.67-4.15], versus 2.92 years [95%CI = 2.92-2.93] for patients without cSCC. ESRD patients with cSCC were at lower risk of death [adjusted hazard ratio = 0.75; 95%CI = 0.69-0.82] compared to those without. Decreased risk of death was also associated with parameters such as black race, Hispanic ethnicity, tobacco dependence and actinic keratosis. Increased mortality risk was associated with increasing age, male sex, hemodialysis (versus peritoneal dialysis) and alcohol dependence. ConclusionsContrary to expectations, ESRD patients with a cSCC diagnosis showed reduced all-cause mortality risk relative to those without. The reason for this discrepancy remains unclear, suggesting the need for further study.

Association between hypomagnesemia and mortality among dialysis patients: a systematic review and meta-analysis.

BackgroundMalnutrition-inflammation-atherosclerosis (MIA) syndrome is caused by the inflammatory cytokines in end stage renal disease (ESRD) patients, and MIA complex-related factors may be associated with hypomagnesemia and mortality. However, the association between serum magnesium level and mortality for dialysis patients is still not clear. Additionally, no meta-analysis has investigated the impact of serum magnesium on peritoneal dialysis and hemodialysis, separately.MethodsWe searched published studies in PubMed, Embase, Cochrane, Collaboration Central Register of Controlled Clinical Trials, and Cochrane Systematic Reviews through April 2022. Studies associated with serum magnesium and all-cause mortality or cardiovascular (CV) mortality in ESRD on kidney replacement therapy (KRT) patients were included. A hazard ratio (HR) with 95% confidence intervals (CI) was used to report the outcomes.ResultsTwenty-one studies involving 55,232 patients were included. Overall, there was a significant association between hypomagnesemia and all-cause mortality for dialysis patients (HR: 1.67, 95% CI [1.412–2.00], p < 0.001; certainty of evidence: moderate) using a mixed unadjusted and adjusted HR for analysis. There was also a significantly increased risk of CV mortality for individuals with hypomagnesemia compared with the non-hypomagnesemia group (HR 1.56, 95% CI [1.08–2.25], p < 0.001; certainty of evidence: moderate). In addition, a subgroup analysis demonstrated that hypomagnesemia was associated with a high risk of both all-cause mortality and CV mortality (all-cause mortality, HR:1.80, 95% CI [1.48–2.19]; CV mortality, HR:1.84, 95% CI [1.10–3.07]) in hemodialysis (HD) patients, but not in participants receiving peritoneal dialysis (PD; all-cause mortality, HR:1.26, 95% CI [0.84–1.91]; CV mortality, HR:0.66, 95% CI [0.22–2.00]). The systematic review protocol was prespecified and registered in PROSPERO [CRD42021256187].ConclusionsHypomagnesemia may be a significant risk factor for all-cause mortality and CV mortality in KRT patients, especially in those receiving hemodialysis. However, because of the limited certainty of evidence, more studies are required to investigate this association.

Could sarcopenia-related mortality in end-stage renal disease be underpinned by the number of hospitalizations and cardiovascular diseases?

To investigate the association between sarcopenia with the number of all-cause mortality, hospitalizations, and cardiovascular diseases in patients with end-stage renal disease (ESRD). 247 patients with ESRD (women, n = 97) (66.6 ± 3.53years) participated in this study. At baseline, all participants were measured with dual-energy X-ray absorptiometry and handgrip dynamometer and were prospectively followed up for 5years. The European Working Group on Sarcopenia in Older People guidelines were utilized for Sarcopenia determination. Cox proportional hazard analysis adjusted for established risk factors was used to quantify the risk between Sarcopenia and all-cause mortality. Sixty-five participants (26%) were determined to have Sarcopenia at baseline and 38 (15%) have died during the follow-up. At baseline, Participants with Sarcopenia had lower body mass index and fat-free mass index. Moreover, through the 5-year follow-up, sarcopenic patients had higher number of cardiovascular disease (56.9% vs. 12.6%) and hospitalizations (93.8% vs. 49.5%) (all P < 0.0001). Sarcopenia was associated with significantly higher risk of mortality, [Hazard ratio = 3.3, (95% CI: 1.6-6.9), P = 0.001]. Sarcopenia may be a risk factor for hospitalizations, cardiovascular diseases, and all-cause mortality in patients with ESRD. These results provide support of the relevance in assessing sarcopenia in the clinical practice of chronic kidney disease and how muscle mass and strength may negatively impact the daily life of ESRD patients undergoing hemodialysis. Greater efforts at preventing muscle wasting and malfunctioning are needed through the worldwide healthcare system.

Mortality outcomes for Māori requiring renal replacement therapy during critical illness: a single unit audit in Aotearoa New Zealand.

Māori in New Zealand (NZ) are disproportionately affected by chronic kidney disease (CKD) and experience lower life expectancy on community dialysis compared with non-Māori. We previously identified a higher renal replacement therapy (RRT) requirement for Māori in our intensive care unit (ICU), the tertiary referral centre for NZ's Te Manawa Taki region. To describe mortality outcomes by ethnicity in the population requiring RRT in our ICU. Retrospective audit of the Australia and NZ Intensive Care Society database for adult admissions to our general ICU from Te Manawa Taki between 2014 and 2018. Patients were stratified by non-RRT requirement (non-RRT), RRT-requiring acute kidney injury (AKI-RRT) and RRT-requiring end-stage renal disease (ESRD). Relative to the population of Te Manawa Taki, Māori were over-represented across all strata, especially ESRD (61.8%), followed by AKI-RRT (35.0%) and non-RRT (32.4%) (P < 0.001). There was no excess mortality by ethnicity in any stratum. Crude in-ICU mortality was similar by ethnicity among AKI-RRT (30.8% among Māori, vs 31.5%; P = 1.000) and ESRD (16.4% among Māori, vs 20.6%; P = 0.826). This trend remained at 1 year. Adjusted for clinically selected variables, neither AKI-RRT nor ESRD mortality was predicted by Māori ethnicity, both in-ICU and at 1 year. Irrespective of ethnicity, AKI-RRT patients had highest in-ICU mortality (31.2%; P < 0.001), while ESRD had highest 1-year mortality (46.1%; P < 0.001). Increased RRT requirement among Māori in our ICU is due to higher representation among ESRD. We did not demonstrate excess mortality by ethnicity in any stratum. AKI-RRT had higher in-ICU mortality than ESRD, but this reversed at 1 year.

Quantitative plaque analysis with A.I.-augmented CCTA in end-stage renal disease and complex CAD

BackgroundAdverse cardiovascular events are a significant cause of mortality in end-stage renal disease (ESRD) patients. High-risk plaque anatomy may be a significant contributor. However, their atherosclerotic phenotypes have not been described. We sought to define atherosclerotic plaque characteristics (APC) in dialysis patients using artificial-intelligence augmented CCTA. MethodsWe retrospectively analyzed ESRD patients referred for CCTA using an FDA approved artificial-intelligence augmented-CCTA program (Cleerly). Coronary lesions were evaluated for APCs by CCTA. APCs included percent atheroma volume(PAV), low-density non-calcified-plaque (LD-NCP), non-calcified-plaque (NCP), calcified-plaque (CP), length, and high-risk-plaque (HRP), defined by LD-NCP and positive arterial remodeling >1.10 (PR). Results79 ESRD patients were enrolled, mean age 65.3 years, 32.9% female. Disease distribution was non-obstructive (65.8%), 1-vessel disease (21.5%), 2-vessel disease (7.6%), and 3-vessel disease (5.1%). Mean total plaque volume (TPV) was 810.0 mm3, LD-NCP 16.8 mm3, NCP 403.1 mm3, and CP 390.1 mm3. HRP was present in 81.0% patients. Patients with at least one >50% stenosis, or obstructive lesions, had significantly higher TPV, LD-NCP, NCP, and CP. Patients >65 years had more CP and higher PAV. ConclusionOur study provides novel insight into ESRD plaque phenotypes and demonstrates that artificial-intelligence augmented CCTA analysis is feasible for CAD characterization despite severe calcification. We demonstrate elevated plaque burden and stenosis caused by predominantly non-calcified-plaque. Furthermore, the quantity of calcified-plaques increased with age, with men exhibiting increased number of 2-feature plaques and higher plaque volumes. Artificial-intelligence augmented CCTA analysis of APCs may be a promising metric for cardiac risk stratification and warrants further prospective investigation.